Malnutrition is a significant issue affecting the health of many adults over the age of 65. Screening for malnutrition in this population can help identify those in need of a complete nutritional assessment. Many screening tools have been developed to aid healthcare team members in identifying those at risk for malnutrition. A population of dietitians with a focus in older adult nutrition was surveyed to determine dietitians’ perceptions and use of screening tools for the older adult. The results of the study showed many dietitians did not use validated screening tools at their place of work and were not confident in their knowledge regarding the topic. Despite dietitians’ having the expertise in nutrition, other interdisciplinary team members are performing the screening in many settings in the United States and some dietitians’ feel this is an obstacle in identifying older adults at risk.

Stroke is the leading cause of disability worldwide. It often leads to mobility limitations resulting from deficits in muscle performance. While reduced muscle strength and rate of force production have been reported, little is known about the power generating capability of people after stroke and its relationship to mobility. Research in other populations has found that measures of muscle power may have a greater association with activity performance than do measures of muscle force alone. Consequently, in an attempt to optimise power, investigators have focused on identifying ideal parameters within which to train for power. One such parameter is the identification of the loading level at which maximal power is generated. Literature reporting optimal loads from both young athletic and healthy older populations has yielded mixed results, making the applicability to a hemiparetic population difficult. The purpose of this study was to investigate muscle power performance at differing loads and to determine at what load muscle power is best elicited in hemiparetic and age and gender matched control groups. A secondary aim was to ascertain whether there is a relationship between the muscle power values obtained and activities such as gait, stair climbing and standing from a chair. Twenty nine hemiparetic volunteers and twenty nine age and gender matched controls were evaluated. Involved and uninvolved legs of the stroke group and a comparison leg of the control group underwent testing. Leg press muscle power was measured using a modified supine leg press machine at 30%, 50% and 70% of a one-repetition maximum (1-RM) load. Participants were positioned on the leg press machine and asked to push, with a single leg, as hard and as fast as they could. Data was collected via a mounted force platform and a linear transducer connected to a platform on which the participants lay. From these, power was able to be calculated. The activities were timed while being performed as fast as possible. The results showed that peak muscle power values differed significantly between the involved, uninvolved and control legs. Peak leg power in all three leg groups was greatest when pushing against a load of 30% of 1-RM. Involved leg peak power tested at 30% of 1-RM (Mean:240; SD:145 W) was significantly lower (p<0.05) than the uninvolved leg (Mean:506; SD:243 W). Both the involved and uninvolved legs generated significantly lower peak power (p<0.05) than the control leg (Mean:757; SD:292 W). Correlations were found between the involved leg peak power and gait speed and involved leg peak power and stair climbing (r=0.6-0.7, p<0.05). No correlation was found between paretic leg peak power and chair stands. The control group leg peak power demonstrated significant associations with the performance of all three activities.In summary, there were significant differences between the involved and the uninvolved leg in power production after stroke. As well, there are significant differences between the uninvolved leg and the leg of those not affected by stroke. Power was related to a number of activities.

abstract: A core principle in multiple national quality improvement strategies is the engagement of chronically ill patients in the creation and execution of their treatment plans. Numerous initiatives are underway to use health information technology (HIT) to support patient engagement however the use of HIT and other factors such as health literacy may be significant barriers to engagement for older adults. This qualitative descriptive study sought to explore the ways that older adults with multi-morbidities engaged with their plan of care. Forty participants were recruited through multiple case sampling from two ambulatory cardiology practices. Participants were English-speaking, without a dementia-related diagnosis, and between the ages of 65 and 86. The older adults in this study performed many behaviors to engage in the plan of care, including acting in ways to support health, managing health-related information, attending routine visits with their doctors, and participating in treatment planning. A subset of patients engaged in active decision-making because of the point they were at in their chronic disease. At that cross roads, they expressed uncertainly over which road to travel. Two factors influenced the engagement of older adults: a relationship with the provider that met the patient's needs, and the distribution of a Meaningful Use clinical summary at the conclusion of the provider visit. Participants described the ways in which the clinical summary helped and hindered their understanding of the care plan. Insights gained as a result of this study include an understanding of the discrepancies between what the healthcare system expects of patients and their actual behavior when it comes to the creation of a care plan and the ways in which they take care of their health. Further research should examine the ability of various factors to enhance patient engagement. For example, it may be useful to focus on ways to improve the clinical summary to enhance engagement with the care plan and meet standards for a health literate document. Recommendations for the improvement of the clinical summary are provided. Finally, this study explored potential reasons for the infrequent use of online health information by older adults including the trusting relationship they enjoyed with their cardiologist. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2015

abstract: Greater than half of older adults who are admitted to an acute care setting experience delirium with an estimated cost between four to twenty billion dollars annually in the United States. As a strategy to address the gap between research and practice, this feasibility study used the Roy Adaptation Model to provide a theoretical perspective for intervention design and evaluation, with a focus on modifying contextual stimuli in a Trauma Intensive Care and a Trauma Orthopedic Unit setting. The study sample included older hospitalized patients in a Trauma Intensive Care and a Trauma Orthopedic setting where there is a greater incidence for delirium. Study participants included two groups, with one group assigned to receive either a music intervention or usual care. The music intervention included pre-recorded music, delivered using an iPod player with soft headsets, with music self-selected from a collection of music compositions with musical elements of slow tempo and simple repetitive rhythm that influence delirium prevention. For the proposed study a music intervention dose included intervention delivery for 60 minutes, twice a day, over a three day period following admission. Physiologic variables measured included systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate, which were electronically monitored every four hours for the study. The Confusion Assessment Method was used as a screening tool to identify delirium in the admitted patients. Specific aims of this feasibility study were to (a) examine the feasibility of a music intervention designed to prevent delirium among older adults, and (b) evaluate the effects of a music intervention designed to prevent delirium among older adults. Findings indicate there was a significant music group by time interaction effect which suggests that change over time was different for the music and usual care group. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2015

abstract: ABSTRACT The population of older adults in the United States is growing disproportionately, with corresponding medical, social and economic implications. The number of Americans 65 years and older constitutes 13.7% of the U.S. population, and is expected to grow to 21% by 2040. As the adults age, they are at risk for developing chronic illness and disability. According to the Centers for Disease Control and Prevention, 5.7 million Americans have heart failure, and almost 80% of these are 65 years and older. The prevalence of heart failure will increase with the increase in aging population, thus increasing the costs associated with heart failure from 34.7 billion dollars in 2010 to 77.7 billion dollars by 2020. Of all cardiovascular hospitalizations, 28.9% are due to heart failure, and almost 60,000 deaths are accounted for heart failure. Marked disparities in heart failure persist within and between population subgroups. Living with heart failure is challenging for older adults, because being a chronic condition, the responsibility of day to day management of heart failure principally rests with patient. Approaches to improve self-management are targeted at adherence, compliance, and physiologic variables, little attention has been paid to personal and social contextual resources of older adults, crucial for decision making, and purposeful participation in goal attainment, representing a critical area for intervention. Several strategies based on empowerment perspective are focused on outcomes; paying less attention to the process. To address these gaps between research and practice, this feasibility study was guided by a tested theory, the Theory of Health Empowerment, to optimize self-management, functional health and well-being in older adults with heart failure. The study sample included older adults with heart failure attending senior centers. Specific aims of this feasibility study were to: (a) examine the feasibility of the Health Empowerment Intervention in older adults with heart failure, (b) evaluate the effect of the health empowerment intervention on self-management, functional health, and well-being among older adults with heart failure. The Health Empowerment Intervention was delivered focusing on strategies to identify and building upon self-capacity, and supportive social network, informed decision making and goal setting, and purposefully participating in the attainment of personal health goals for well-being. Study was feasible and significantly increased personal growth, and purposeful participation in the attainment of personal health goals. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2017

Orientador: Monica Sanches Yassuda / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-08T05:14:06Z (GMT). No. of bitstreams: 1 Ribeiro_PricilaCristinaCorrea_M.pdf: 598223 bytes, checksum: f850560d25f8ba7f713dd85fa546cf6b (MD5) Previous issue date: 2006 / Resumo: O presente estudo analisou a relação entre desempenho cognitivo e a freqüência de participação em atividades físicas e ocupacionais (instrumentais, sociais e intelectuais) objetivando identificar fatores do estilo de vida associados ao bom funcionamento cognitivo em idosos. A amostra foi constituída de 155 idosos do banco de dados do Estudo PENSA (Estudo dos Processos de Envelhecimento Saudável), que entrevistou indivíduos com 60 anos ou mais residentes na comunidade de Juiz de Fora/MG. Essa amostra distribui-se em 28% de homens e 72% de mulheres, com média de 70,25 anos de idade (DP=8,21) e 6,73 (DP=4,38) anos de estudo. Para avaliação do desempenho cognitivo foram aplicados testes da bateria do CERAD (Consortium to Establish a Registry for Alzheimer¿s Disease) e para levantamento da freqüência de realização de atividades foi utilizado o auto-relato. O aumento da idade não se destacou como determinante do engajamento em um estilo de vida ativo. Foram detectadas diferenças entre gênero e nível sócio-econômico na freqüência de realização das atividades. Os homens mostraram-se mais participativos em atividades físicas e as mulheres em atividades instrumentais, intelectuais e sociais. Maior freqüência de realização das atividades ocupacionais esteve associada a mais anos de estudo e maior renda familiar. No desempenho cognitivo, observou-se média de 13,68 (DP=4,5) palavras no teste de fluência verbal; 11,95 (DP=2,66) figuras corretamente nomeadas no teste de nomeação de Boston; 15,45 (DP=4,61) palavras no teste de memória; 5,2 (DP=2,47) palavras na evocação tardia e 9,08 (DP=2,78) palavras no reconhecimento da lista de palavras; 7,64 (DP=3,28) pontos no teste de praxia e 4,52 (DP=3,61) ontos na evocação das praxias. Entre as variáveis sócio-demográficas, idade e escolaridade tiveram efeito significativo sobre o desempenho cognitivo. Os efeitos do estilo de vida ativo na cognição foram modestos. Quando controlados os efeitos da idade e da escolaridade, nenhuma relação entre atividade física e cognição foi demonstrada documentou-se relação significava entre atividades ocupacionais e o teste de praxia construtiva. Os resultados deste estudo mostraram que nesta sub-amostra do PENSA a freqüência da realização de atividades não apresentou impacto na cognição dos idosos de maior magnitude que os aspectos sócio-demográficos / Abstract: The present study investigated the relationship between cognitive performance and frequency of participation in physical and daily activities (instrumental, social, and intelectual). The goal was to identify aspects of life style that might be related to high cognitive performance in older adults. The sample was formed by 155 community dwelling older adults from Juiz de Fora, 60 and older, who participated in the PENSA study (Healthy Aging Processes Study). 28% were men and 72% were women, mean age was 70,25 years (SD= 8,21) and they had in average 6,73 (SD=4,38) years of education. To evaluate cognitive performance, selected tests from the CERAD (Consortium to Establish a Registry for Alzheimer¿s Disease) battery were used and frequency of participation in activities was based on self report. Increase in age did not determine engagement in active life style. Significant differences related to gender and and socio-economic status were detected in the frequency of activity engagement. Men participated more frequently in physical activities and women in instrumental, social and intellectual activities. Higher frequency of daily activities was associated with higher education and higher income. As to cognitive performance, participants generated 13,68 (DP=4,5) words in the verbal fluency test; 11,95 (DP=2,66) pictures were correctly named in the Boston naming test; 15,45 (DP=4,61) words were correctly recalled in 3 immediated recalls; 5,2 (DP=2,47) words were recalled in the delayed recall and 9,08 (DP=2,78) words were correctly recognized; 7,64 (DP=3,28) points for constructional praxis and 4,52 (DP=3,61) points in the recall of constructional praxis. Among socio-demographic variables, age and education had a significant effect on cognitive performance. The effect of active life style on cognition was modest. When age and education were controlled, no significant relation was detected between physical activity and cognition, however, there was a significant relation between frequency of occupational activities and constructional praxis. The results of this study indicated that in this PENSA sub sample the frequency of engagement in activities did not have a stronger effect on cognition than socio-demographic variables / Mestrado / Mestre em Gerontologia

Introdução: A anemia é a disfunção hematológica mais comumente encontrada nas pessoas idosas tendo, entre os que residem na comunidade, uma prevalência próxima de 10 por cento . Associa-se a várias condições crônicas e tem significativo impacto nos desfechos de saúde como fragilidade, mobilidade comprometida e comprometimento funcional. Objetivo: Avaliar os fatores associados à anemia e sua associação com desfechos adversos em saúde nas pessoas idosas do município de São Paulo. Métodos: Estudo observacional transversal de base populacional, com amostragem probabilística representativa, onde foram avaliados 1256 pessoas com idade igual e superior a 60 anos em 2010. A anemia foi diagnosticada a partir da concentração sanguínea de hemoglobina, de forma contínua e categorizada segundo parâmetros estabelecidos pela OMS (mulheres:<12g/dL; homens:<13g/dL). A regressão logística hierárquica foi utilizada para avaliar os fatores associados à presença de anemia e a associação de anemia com desfechos adversos em saúde. Resultados: A prevalência de anemia foi de 7,7 por cento na população e os fatores significativamente associados após ajuste foram idade mais avançada, diabetes e câncer referidos e presença de sintomas depressivos. Em relação aos desfechos adversos, a anemia permaneceu significativamente associada à fragilidade (OR=5,19; IC95 por cento =2,41-11,20) e mobilidade comprometida (OR=2,10; IC95 por cento =1,19-3,69). Com relação à concentração de hemoglobina, quanto maiores os valores, menores as chances de fragilidade (OR=0,91; IC95 por cento =1,03;1,08) e mobilidade comprometida (OR=0,81; IC95 por cento =0,67;0,97). As probabilidades de ocorrência de desfechos adversos quando se adota os parâmetros estabelecidos pela OMS são próximas de 20 por cento . Conclusão: A prevalência de anemia em pessoas idosas residentes no Município de São Paulo se aproxima de valores encontrados em outras populações. A doença foi associada à idade avançada, presença de diabetes, câncer e sintomas depressivos. Entre os desfechos adversos, a anemia foi associada à mobilidade comprometida e fragilidade. A alta probabilidade de ocorrência desses desfechos quando se considera os parâmetros vigentes reforça a necessidade de discutir a adequação dos pontos de corte para esse grupo etário, que auxiliaria na atuação mais precoce dos profissionais de saúde no tratamento da anemia e, consequentemente, evitaria, postergaria ou reverteria os desfechos adversos associados à doença. / Introduction: Anemia is the most commonly hematologic disorder in older adults, with a prevalence of approximately 10 per cent in community-living elderly. It is associated with several chronic diseases and other adverse health outcomes, such as impaired mobility, frailty and difficulties in activities of daily living (ADL). Objective: To evaluate factors associated to anemia and its relationship with adverse health outcomes in the older adults living in São Paulo, Brazil. Methods: An observational cross-sectional population-based study, with a representative sample, which evaluated 1256 elderly ( 60 years) in 2010. The hemoglobin blood concentration was considered continuous or categorized as anemia according to WHO cutoffs (women: <12g/dL; Men: <13g/dL). We used hierarchical logistic regression to assess factors associated with the presence of anemia, and to evaluate the association of anemia with adverse health outcomes. Results: The prevalence of anemia was 7.7 per cent , among older adults, and the factors that remain statistically significant after adjustment are higher age, presence of diabetes, cancer and depressive symptoms. When considering adverse health outcomes, anemia remained significantly associated with frailty (OR=5.19, 95 per cent CI=2.41,11.20) and mobility difficulty (OR=2.10, 95 per cent CI=1.19, 3.69). Hemoglobin continuous concentration showed negative effect on the probability of outcomes - the higher the blood hemoglobin, the less chance of frailty (OR=0.91, 95 per cent CI=1.03,1.08) and mobility difficulty (OR=0,81, 95 per cent CI=0.67, 0.97). The probabilities of outcomes when the current cutoffs for anemia are adopted are about 20 per cent . Conclusion: The prevalence of anemia in the older adults in São Paulo is close to the values found in other populations. The disease was associated with advanced age, presence of diabetes, cancer and depressive symptoms. Among health outcomes, anemia was associated to impaired mobility and frailty.The high probability of outcomes when the current WHO cutoff are take into account reinforces the discussion of rising the cutoff points for the older population, and even if it brings a greater burden for health services, it could help health professionals in early intervention for treatment of anemia, and thus prevent, delay or reverse the adverse outcomes.

Telehealth has great potential for providing timely and comprehensive care to community-dwelling older adults while reducing their barriers to healthcare access. The purpose of this study is to understand how older adults with chronic diseases access healthcare services in their community and evaluate the impact of telehealth on access to care from a self-reported survey conducted in British Columbia. About a quarter of older adult participants reported barriers to healthcare access in their community. Participants frequently reported financial barriers to healthcare access regardless of telehealth use. In addition, telehealth users more frequently reported a lack of necessary healthcare services in their community and physical barriers to access to care. Although the findings did not demonstrate a significant difference in access to care between telehealth users and nonusers, telehealth was identified as a meaningful care delivery tool for older adults with barriers to healthcare access. Further efforts are needed to implement a valid tool for ongoing evaluation and optimization of telehealth and integrate telehealth into clinical and community programs to reduce physical and financial barriers to healthcare access for community-dwelling older adults with chronic illnesses. / Graduate

Despite the well-known benefits of physical activity, in 2012, only 37.5% of older adults aged 60 years or older met recommended aerobic physical activity levels and 16.1% met muscle-strengthening guidelines. Effective exercise programs can help combat the problem of inactivity but 50% of those who start participating in an exercise program drop out within first few weeks, preventing them from gaining any health benefits. Since fall 2008, the Healthy Aging Regional Collaborative of South Florida has offered EnhanceFitness (EF), an evidence-based physical activity program to older adults. This dissertation compared EF effectiveness at 4-, 8-, and 12-months and examined the factors that were associated with program completion. A paired sample t-test identified changes at 4-months and repeated measures design was used to identify changes from baseline to 4-, 8-, and 12- months. Logistic regression was used to identify correlates associated with completion. Between October 1, 2008 and December 31, 2012, 4,531 older adults (>=60 years) attended one or more EF sessions. Participants showed significant improvement in the number of chair stands performed in 30-seconds with mean change of 1.7, 1.6, and 2.0 respectively at 4-,8-,and 12- months (pp<0.001). Results suggest Black, non-Haitian men were less likely to complete the program when compared to white, non-Hispanic men (OR=0.41, p=0.02). Men who self-reported having at least one risk factor were more likely to complete the program (OR=1.81, p= 0.03). In addition, women who lived in Miami-Dade County (OR=2.13, ppppp<0.01). Effectiveness results revealed that all participants improved on outcome measures. However, improvement is more than double for those who completed recommended sessions (p

For decades, sexual expression in older adulthood was a taboo topic in the public discourse and ignored in the empirical literature. As a result of several significant sociocultural changes and medical developments as well as an increasingly older population, however, perspectives are shifting and acceptance and interest in the sexual lives of older adults is growing. The purpose of this dissertation was to investigate sexual well-being in older adulthood and explore its diversity. Study 1 involved a systematic review of the literature on factors associated with the maintenance and cessation of sexual activity in adults 60 years of age and older. Data were extracted from a total of 57 studies and each was assessed for methodological quality. Surprisingly, only four factors (i.e., partner’s interest in sexual activity, past frequency of sexual activity, presence of erectile dysfunction, and partner-related illness) were consistently related, in more than one study, to whether or not older adults were sexually active. Significant variability in study results highlighted methodological caveats of the body of literature, but also the heterogeneity of older adults’ sexuality. Study 2 built upon the findings and recommendations of Study 1 and further examined diversity in sexual well-being. Sexual function and satisfaction, the absence of sexuality-related distress, breadth of sexual experience, and overall frequency of sexual activity were considered as indicators of sexual well-being. The Dual Control Model of Sexual Response (DCM) was used as the theoretical framework in this study of women 50 years of age and older. The DCM posits that sexual response depends on the relative activation of sexual excitatory and sexual inhibitory processes, two separate and independent systems. Study 2 results indicated that, independently, women’s propensities for sexual excitation and sexual inhibition were significantly associated with the majority of the indicators of sexual well-being and the directions of associations were consistent with the tenets of the DCM. The only association that proved not statistically significant was the relationship between sexual excitation and sexual distress. When examined together, sexual excitation and sexual inhibition factors significantly predicted sexual function, satisfaction, and frequency. Sexual distress was predicted more strongly by sexual inhibition factors and sexual breadth by sexual excitation factors. Partner physical and mental health and participant mental health were further identified as moderating variables of these associations. The results of Study 2 expand current knowledge regarding the DCM and its relevance to older women; sexual excitation and sexual inhibition appear to have heuristic value to better understand the variability in sexual activity and well-being in women aged 50 years and older. The results of this dissertation have important implications for the study of sexuality and ageing, perhaps most prominently in terms of highlighting the inter-individual variation in older adulthood and the conclusion that generalizations about “older adults” as a group may not be appropriate.